NPIMap

Organization Active NPI

Active Sports Rehab Physical Therapy, Inc.

Doing business as Active Sports Rehab Physical Therapy

  • Physical Therapist
  • Buena Park, CA
National Provider Identifier
1194309542
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ACTIVE SPORTS REHAB PHYSICAL THERAPY, INC.
Doing business as
Active Sports Rehab Physical Therapy
Practice address
6850 Lincoln Ave Ste 205
Buena Park, CA 90620-4180
Phone
(714) 527-9240
Fax
(714) 527-9230
NPI assigned
May 11, 2021
Last updated
May 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chris Bollier
Title
Business Manager
Phone
(562) 650-5294

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

6850 Lincoln Ave Ste 205
Buena Park, CA 90620-4180

Mailing address

6850 Lincoln Ave Ste 205
Buena Park, CA 90620-4180

Other names 1

  • Active Sports Rehab Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210729003669 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5991108896 Receives reassigned benefits from 1 practitioner
Practice locations: Buena Park, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1194309542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6850 LINCOLN AVE STE 205",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906204180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6850 LINCOLN AVE STE 205",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906204180",
            "telephone_number": "714-527-9240",
            "fax_number": "714-527-9230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE SPORTS REHAB PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-11",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "BOLLIER",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "562-650-5294"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Sports Rehab Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buena Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.